While the latest disruption capturing public attention may be Amazon’s entree into the grocery business, a major transformation is being debated within the Massachusetts Legislature over eye care - who can treat glaucoma as well as minor eye infections.

The political maneuvering is pitting optometrists, doctors carrying an O.D. degree obtained after a four-year, post-college study at an institutions like MCPHS University, which has a campus in downtown Worcester; and ophthalmologists, physicians carrying an M.D. obtained after four years of post-college study in medical schools, such as UMass Medical School in Worcester, and who undergo a one-year internship, and then three-to-five years of residency/fellowship in their specialty.

The existing symbiosis in which optometrists refer patients to ophthalmologists could be altered for some patients with glaucoma, as well as those with routine eye infections. Optometrists want the ability to provide immediate, first-line treatment of glaucoma with eye drops that reduce the condition’s elevated eye pressure and to treat minor eye infections such as styes and dry eye with oral antibiotics.

The Massachusetts Senate has approved this expansion in some form at least six times, only to see it die in the House. The Senate’s latest version has been incorporated into the July 1 budget proposal by the Baker Administration under the assumption it will save the state’s MassHealth (Medicaid) system $20 million a year. But what gets to the governor’s desk also depends on what the House does.

Making this all the more remarkable in its political maneuvering is that 49 states have all allowed optometrists to treat glaucoma in this fashion. The U.S. Veterans Administration medical system allows optometrists to provide this first-line treatment. (Three states even allow optometrists to perform laser surgery – although the other side says they’re rural states where medical access can be an issue.) Last year, the Obama Administration Justice Department’s Antitrust Division and the Federal Trade Commission bureaus of Competition and of Economics weighed in supporting a Massachusetts change.

Deanna Ricker, M.D., president of the Massachusetts Society of Eye Physicians and Surgeons, says the measure’s wording is too vague. A specified prohibition against “invasive surgical procedures,” for instance, leaves open a possibility that optometrists might be allowed to perform laser surgery, as “non-invasive,” just for one. She has said the $20-million MassHealth savings, from a study done for optometrists by a former MassHealth director, “falsely inflates” savings in assumptions of how people would access care.

Matthew Forgues, O.D., who is president of the Massachusetts Society of Optometrists and who practices in Worcester and Shrewsbury, points to the experience of all the other states, going back as far as 40 years, without issue. He says the fact that optometrist malpractice insurance rates in Massachusetts are no different from elsewhere shows that the expanded treatments aren’t causing problems.

Charles F. Monahan Jr., president of MCPHS University, where about 280 students studying optometry out of 2,000 in the city, lives this 49-to-1 split. Students come from all over the U.S., Canada and overseas. Their accredited training includes treatment for glaucoma and eye infection. They graduate, go home and put that education into practice, except for those graduates remaining in Massachusetts.

Shlomit Schaal, M.D., chair of the Department of Ophthalmology at UMass Memorial Medical Center and UMass Med, cited the disruptive nature of these moves across the country – not surprising given that politically there are significantly more optometrists than ophthalmologists. But because glaucoma is a progressive disease, she points out that even questions of when to stop a treatment and make a referral for surgery by a glaucoma specialist can be very challenging. Dr. Schaal is pioneering efforts to bring ophthalmologists and optometrists together in a UMass/MCPHS “eye to eye” symposium twice a year on patient care, as well as in monthly seminars. She finds that each group brings perspectives that benefit the other.​It’s time Massachusetts joins the rest of the country. It will improve access to care and lower costs. We’d like to see a thorough reading of practices allowed in each state, and adjustments to the legislation’s wording to avoid any unintended fallout.

Mirroring the gulf between the U.S. House and Senate on national health care legislation, our lawmakers on Beacon Hill are also split and mired in debate.

Leading off - Legislative leaders have set a June 30 deadline to get a marijuana bill to Governor Baker. Of course, Bay State voters already approved a referendum legalizing marijuana. The Massachusetts House and Senate want to improve the bill but can't agree on how. One example: Last week the House approved a 28 percent tax on sales - more than double the rate approved by voters and one which critics say will encourage black market sales. The two bodies also disagree on how cities and towns can ban or control pot shops and marijuana facilities. A final compromise is needed, or the voters' mandate will go up in smoke.

Massachusetts is the only state in the union preventing optometrists from treating glaucoma and other minor eye infections. It’s an "eye for an eye" dispute between ophthalmologists and optometrists over who has the right -- and the medical know- how-to administer care. Six times, the Massachusetts Senate has approved expanding the treatment role for optometrists, only to see it die in the House. With almost five times the number of optometrists –- and resulting lower costs -- the new Senate version asserts savings in the MassHealth system of $20 million a year. That's a market based solution --, and savings --, worthy of support and enacting in both chambers.​Also on the docket, the state Senate debates a bill expanding 2010’s "no texting while driving law" to require hands free or a voice-activated function for all cell or device use while driving. In the past seven years technology has advanced, while distracted driving has grown exponentially, killing in even greater numbers. It is time for Beacon Hill to summon the political will to make the roads safer.

​Massachusetts optometrists are taking to the airwaves to make another hard charge at stalled legislation that would allow them to treat glaucoma and other eye conditions that now require an ophthalmologist.

They may as well have an audience of one — House Majority Leader Ron Mariano, who is trying to use his political muscle within his chamber’s leadership to again quash the legislation that has already passed the State Senate and is backed by Governor Charlie Baker.

The intriguing political question is whether Mariano’s close political ally and trusted friend, House Speaker Robert A. DeLeo, will hold the line for him on an issue about which the majority leader has strong feelings.

The optometrists’ latest move is to pressure the House to go along with a Senate budget amendment that gives them the right to treat certain eye ailments, a change that they say would save the state $20 million. The group’s $25,000 worth of radio ads will run for ten days.

The ads come just as Baker is trying to turn up the heat on the House over that bill. It is among several legislative proposals to expand the “scope of practice” for acupuncturists, physical therapists, and dental hygienists.

But Mariano made clear this week he is not budging in his opposition, saying that the expansion of “scope of practice” proposals — which he has fought for years — are nothing but money­grabs by medical professionals who want to perform special procedures for which they are not qualified . Optometrists, who are not doctors, must now refer glaucoma cases and other eye conditions to opthamologists.

For Mariano, the point is simple: it’s an important medical practice decision that shouldn’t be decided by politicians voting in the state House and Senate.

“We should not be making health care decisions like this politically,’’ said the Quincy Democrat.

The Massachusetts Medical Society and Massachusetts Society of Eye Physicians and Surgeons also oppose the legislation. Forty­nine other states allow optometrists to perform such procedures as eye­drops for glaucoma.

But medical debate aside, the legislation is teeing up an interesting internal political dynamic in the House. Specifically, how long will DeLeo stand behind his majority leader?